Robotic-assisted laparoscopic prostatectomy (RALP) procedures have become more common over the years, but post-surgery erectile dysfunction and urinary incontinence are problems for many men. As a result, some patients opt for inflatable penile prostheses, which can give them an erection when desired, and artificial urinary sphincters, which can stop urine from leaking.

Each of these devices requires the placement of a reservoir. After a radical retropubic prostatectomy, the space of Retzius is usually available for this purpose. However, as RALP is an intraperitoneal procedure, this space is often no longer viable. It can be difficult to find an alternative and it’s possible for the device to erode into the bowel or bladder. It may also cause vascular injury.

In an article published in April in Sexual Medicine Reviews, urologists from the University of North Carolina Chapel Hill describe two cases of venous thrombosis after such procedures.

The first case involved a 59-year-old African-American man who underwent radical retropubic prostatectomy and implantation of an artificial urinary sphincter. The patient eventually developed a large scrotal hematoma and compression of the left femoral vein. The reservoir was then moved to a midline subfascial area. His condition has improved and his device is working normally.

The second case involved a 64-year-old man who had had a RALP procedure for prostate cancer. He later had an inflatable penile prosthesis implanted because of erectile dysfunction. Three days later, he had painless swelling in his right lower extremity and an acute venous occlusion was eventually found. Surgeons discovered that the prosthesis reservoir had moved into the deep pelvis. The reservoir was removed and a replacement was put under the rectus muscle in the midline. At his last follow-up, there were no problems with thrombosis or with the patient’s prosthesis.

The authors noted other options for alternative or ectopic reservoir placement if the paravesical space is scarred. They also stressed that surgeons should have “a thorough understanding of abdominal wall anatomy.”

“Urologists should be familiar with these complications and recognize that lower extremity swelling could be related to venous obstruction from the reservoir or [pressure regulating balloon (PRB)]. Techniques for ectopic placement of reservoirs and PRBs can be useful to prevent these complications,” they wrote.